National Provider Identifier [NPI]: |
1053554089 |
Last Name Of The Provider |
MARQUIS |
First Name Of The Provider |
SEAN |
Middle Initial Of The Provider |
W |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1000 MINERAL POINT AVE |
Street Address 2 Of The Provider |
|
City Of The Provider |
JANESVILLE |
Zip Code Of The Provider |
535482940 |
State Code Of The Provider |
WI |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Emergency Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
23 |
Number Of Services |
328 |
Number Of Medicare Beneficiaries |
271 |
Total Submitted Charge Amount |
175423.76 |
Total Medicare Allowed Amount |
39819.68 |
Total Medicare Payment Amount |
30175.96 |
Total Medicare Standardized Payment Amount |
31297.57 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
0 |
Number Of Drug Services |
0 |
Number Of Medicare Beneficiaries With Drug Services |
0 |
Total Drug Submitted ChargeAmount |
0 |
Total Drug Medicare AllowedAmount |
0 |
Total Drug Medicare PaymentAmount |
0 |
Total Drug Medicare Standardized Payment Amount |
0 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
23 |
Number Of Medical Services |
328 |
Number Of Medicare Beneficiaries With Medical Services |
271 |
Total Medical Submitted Charge Amount |
175423.76 |
Total Medical Medicare Allowed Amount |
39819.68 |
Total Medical Medicare Payment Amount |
30175.96 |
Total Medical Medicare Standardized Payment Amount |
31297.57 |
Average Age Of Beneficiaries |
67 |
Number Of Beneficiaries Age Less65 |
103 |
Number Of Beneficiaries Age 65 to 74 |
66 |
Number Of Beneficiaries Age 75 to 84 |
55 |
Number Of Beneficiaries Age Greater 84 |
47 |
Number Of Female Beneficiaries |
157 |
Number Of Male Beneficiaries |
114 |
Number Of Non Hispanic White Beneficiaries |
183 |
Number Of Black or African American Beneficiaries |
73 |
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
|
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
129 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
142 |
Percent Of With Atrial Fibrillation |
21 |
Percent Of With Alzheimers Disease or Dementia |
22 |
Percent Of With Asthma |
19 |
Percent Of With Cancer |
12 |
Percent Of With Heart Failure |
41 |
Percent Of With Chronic Kidney Disease |
52 |
Percent Of With Chronic Obstructive Pulmonary Disease |
25 |
Percent Of With Depression |
44 |
Percent Of With Diabetes |
41 |
Percent Of With Hyperlipidemia |
49 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
46 |
Percent Of With Osteoporosis |
12 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
47 |
Percent Of With Schizophrenia Other PsychoticDisorders |
17 |
Percent Of With Stroke |
8 |
Average HCC Risk Score Of Beneficiaries |
2.9522 |